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Policy Number: MGL0201449 Mt. Hawley Insurance Company <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - <br /> SCHEDULED PERSON OR ORGANIZATION <br /> This endorsement modifies insurance provided under the following: <br /> COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> SCHEDULE <br /> Name Of Additional Insured Person(s) <br /> Or Organization(s): Location(s) Of Covered Operations: <br /> All persons or organizations where required All Locations <br /> by written contract executed prior to the <br /> commencement of your work. <br /> Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br /> A. Section II — Who Is An Insured is amended to in- not be broader than that which you are required <br /> clude as an additional insured the person(s) or organi- by the contract or agreement to provide for such <br /> zation(s) shown in the Schedule, but only with respect additional insured. <br /> to liability for "bodily injury", "property damage" or <br /> "personal and advertising injury" caused, in whole or B. With respect to the insurance afforded to these <br /> in part, by: additional insureds, the following additional exclusions <br /> apply: <br /> 1. Your acts or omissions; or <br /> This insurance does not apply to "bodily injury" or <br /> 2. The acts or omissions of those acting on your "property damage" occurring after: <br /> behalf; <br /> 1. All work, including materials, parts or equipment <br /> in the performance of your ongoing operations for the furnished in connection with such work, on the <br /> additional insured(s) at the location(s) designated project (other than service, maintenance or re- <br /> above. pairs) to be performed by or on behalf of the addi- <br /> tional insured(s) at the location of the covered <br /> However: operations has been completed; or <br /> 1. The insurance afforded to such additional insured 2. That portion of"your work" out of which the injury <br /> only applies to the extent permitted by law; and or damage arises has been put to its intended use <br /> by any person or organization other than another <br /> 2. If coverage provided to the additional insured is contractor or subcontractor engaged in performing <br /> required by a contract or agreement, the in- operations for a principal as a part of the same <br /> surance afforded to such additional insured will project. <br /> CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 <br /> Insured <br />